GPs should reduce antibiotic prescribing for COPD, says NICE

GPs should limit the amount of antibiotics that they prescribe to COPD patients experiencing exacerbations, according to new draft guidance from NICE.

GPs should reserve antibiotics for severe exacerbations only and take in to account symptoms and history inpatients whose exacerbation is not severe before prescribing, according to NICE.

The guideline recommends that patients with severe acute exacerbations are prescribed an antibiotic and that in non-severe exacerbations, GPs should consider factors such as the number and severity of symptoms, their previous exacerbation history and the risk of antimicrobial experience before prescribing antibiotics.

The guideline also suggests that if an antibiotic is prescribed, the choice of drug should be reviewed when microbiological results from a sputum sample become available.

It reminds GPs that exacerbations can be caused by factors such as viral infections and smoking and advises on safety-netting if the decision is made not to prescribe.

Professor Mark Baker, director of the centre for guidelines at NICE, said: ‘The evidence shows that there are limited benefits of using antibiotics for managing acute exacerbations of COPD and that it is important other options are taken into account before antibiotics are prescribed.

‘The new guideline will help healthcare professionals make responsible prescribing decisions to not only help people manage their condition but also reduce the risk of resistant infections.’

The draft COPD antimicrobial prescribing guideline is open for consultation until 31 July 2018.

Readers' comments (8)

Last week - stock ‘em up with prophylactic antibiotics on demand.
This week - don’t give ‘em nowt.
Anyone following this advice is a pneumo-sepsis away from a date with the GMC, good luck telling them you were just following guidelines......

I have noticed that some COPD patients order their rescue medication very frequently, sometimes once a month. Educating them is very difficult. It tends to be the anxious patients who almost take them just in case without giving themselves time to see if they would improve without the antibiotics.

COPD "rescue packs" are a short course of antibiotics and oral steroids which help COPD patients with moderately severe attacks/exacerbations. For milder attacks higher dose of salbutamol via a spacer will often suffice with increased fluid intake. Self management and training is the key - and patient self management plans e.g. from BLF can be a big help.

Locally in East Kent we follow a traffic light system to distinguish mild/moderate/severe attacks.
One must remember that upto 50% of severe attacks needing admission can have pneumonia as per Hospital data we have locally.

GPs are also under pressure to prescribe relentless rounds of antibiotics and steroids in order to prevent admissions to overflowing, overburdened hospitals. Meanwhile antibiotic resistance mounts. I agree with David Banner. The blame culture that we work in and the GMCs persecution of doctors limits sensible rationing of precious resources.

We also have our secondary care colleague ask us to prescribe off listen ear long term prophylaxis for COPD patients.With the promise it will soon be routine.I then ask them to take responsibility and supply the scripts.The advice is soon backtracked upon.

'faithful hound' has been misled and Neil Banik is deluded.
All COPD patients are meant to be on continuous antibiotics, including macrolides and broad-spectrum penicillins, with the addition of another, such as third-generation cephalosporin or doxycycline at the first signs of a cold or runny nose, as that is whet the Consultants have prescribed, and sine they are allowed to self-medicate with rescue packs up to every week if necessary, there is nothing GPs can do about this profligate waste of antibiotic resources, because the Specialists have ordered it!
The cause was lost years ago when we let secondary care 'specialist' nurses see these patients in hospital clinics and advise the Consultants.

I agree entirely. the problem is that I don't recall it being GPs that initiated this blanket antibiotic/steroid "In-case" strategy in the first place. as rightly stated it was promulgated by the "Experts" and dumped on General Practice as a belief that it would reduce some strain [yet again] on hospital admissions.
The swing seems to be returning if not mistaken to an odd phrase of "Use clinical judgement?" - perish the thought! The problem here is that blanket dic-tats have eroded the very skills needed to do this and demoralised those who have tried.